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DS-19-1333Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: DS-06-19-1333 PGM �ry���"�' t, J Permit Type: Driveways/Sidewalks/Slabs Ir Work Classification: Addition/Alteration Permit Status: Approved issue Date: 06/12/2019 1 Expiration: 12/09/2019 Location Address Parcel Number 910 NE 91ST TER, Miami Shores, FL 33138 1132060000020 Contacts TRACY KNIGHT Owner 910 NE 91 TERR, MIAMI SHORES, FL 331383220 HOME OWNER Contractor HOME OWNER Description: REMOVE EXISTING CONCRETE DRIVEWAY AND Valuation: $ 2,500.00 Inspection Requests: REPLACE WITH NEW CONCRTE WITH FIBER GLASS Total Sq Feet: 550.00 11 Fees Amount Application Fee - Other $50.00 CCF $1.80 Concrete/asphalt/pavers, slabs, dways, $75.00 swalks DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.60 Planning and Zoning Review Fee $35.00 Scanning Fee $9.00 Technology Fee $3.13 Total: $178.53 Payments Date Paid Amt Paid Total Fees $178.53 Credit Card 06/12/2019 $178.53 Amount Due: $0.00 Building Department Copy In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: Irtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulatiArponstru i nd zoning. Futhermore, I authorize the above named contractor to do the work stated. Owner / Applicant / Contractor / Agent Date June 12, 2019 Page 2 of 2 BUILDING PERMIT APPLICATION Miami Shores Village vEG Building Department R �o 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 '(201 FBC j� Master Permit No. ✓` —1 — 13—:33 Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP �j p� /�/� CONTRACTOR DRAWINGS JOB ADDRESS: 1 10 N L' I ��� 1 i I) G1 M l �7 Ch ono-5 FL 33 13 8' City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:/! - 3,?64 20 Is the Building Historically Designated: Yes NO Occupancy Type: 5 rd Load: Construction Type: Flood Zone: BFE: FFE: A756-aai-1-7;�i OWNER: Name (Fee Simple Titleholder): T1066,4106MaSn / Phone#: 30J - 769 - -7,69 p Address: I t ig o f q,,) J E r", City: 1, rl M1 sholPS Stater Zip: 53139' Tenant/Lessee Name: L - Phone#: ,�Db'L-]fig— iS67 Email:_ kQlgGlt//`/�e ����UTI/(. E CONTRACTOR: Company Name: i Ibm`� \�y� r Phone#: Address: City: State: Zip: Qualifier Name: State Certification or Registration #: DESIGNER: Architect/Engineer: one#: Certificate of Competency #: hone#: Address: City: T,.�tel4{I►tl�!/, State: Zip: Value of Work for this Permit: Square/0ic_ar Footage•of WarJc)� 6.50 5,7. 4- Type of Work: ❑ Addition ❑ Alteration Description of Work: AfiVou3nij t Specify color of color thru tile: Submittal Fee $ t---)— Permit Fee $ Scanning Fee $ Technology Fee $ Structural Reviews $, (Revised02/24/2014) Radon Fee $ ❑ New epair/Replaci V ems Training/Education Fee $ ❑ Demolition CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ 5-W' O'�) TOTAL FEE NOW DUE $ I-1� • S3 6%, C_'-3 . Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City I State Zip Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature V Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this _0 6-�" da of V Y1� 20 (I , by Tr t � who is personally known to me or o has produced `il / I I 1r1S as identi icatio a d o did take an ��������Y pR/ //ok OTA Y PUB I � � �CI�H2aS,V2•• i Sig •*� Print: The foregoing instrument was acknowledged before me this day of me or who has produced 20 , by who is personally known to identification and who did take an oath. NOTARY PUBLIC: Sign: • n�� Print: Seal: U ',�Vz; ' ,*STAirc V�```• Seal: as APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: �I (,l.Ir kA1 j Q' DATE: (0 ADDRESS: l0 NC `I 1 �re (, Mi aAl i 5►'lO%Qs Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103( 7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that � ds the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractor. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one -family or two-family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F_I.C.A and with -holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1, 1 understand that state law requires construction to be done by a licensed contractor and have applied for an owner -builder permit under an exemption from the law. The exemption specifies that 1, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial 2 1 understand that building permits are not required to be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. Initial 3. 1 understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts. Initial J a!"� [ 4. 1 understand that I may build or improve a one family or two-family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built w substantially irproved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I built or substantially improved it for sale or lease, which violates the exempton Initial_ 5. 1 understand that, as the owner -builder, I must provide direct, onsite supervision of the construction. Initial fi. 1 understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building; or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law and by county or municipal ordinance. Initial 7. 1 understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner -builder permit that erroneously implies that the property owner is providing his or her own labor and materials. 1, as an owner -builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner -builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial- :V:� 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform tale work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions uncer the Federal Insurance Contributions Act (FICA) and must provide workers compensation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial T/1,_ 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable lav s and requirement that govern owner -builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. �KInitial__ 10. 1 understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues, I also understand that I may contact the Florida Construction Industry Licensing Board at 850,487.1395 or http://www.myfloridalicense.com/dbpr/pro/cilb/index.html Initial �� 11. 1 am aware of, and consent to; an owner -builder building permit applied for in my name and understands that. I am the party legally and financially responsible for the proposed construction activity at the following address: 1l0 YG ql��i A r��id� ' Initial K 12. 1 agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of the information that I have provided on this disclosure. Initial Licensed contractors are regulated by laws designed to protect the public. if you contract with a person who does not have a hcensel, the Constr4uction Industry licensing Board and Department of Business and professional Regulation may be unable to assist you with anv financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed rontractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner -builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this -day of 4Vjw , 20 h By 11OIC �ni rl� who was personally known to me or who has Produced ther 4 ense or OWNER as identification : + a '; gym; Z 2 � v � bTliif ��j//ZM- STA1i . �����► Miami shores Village Building Department SURVEY AFFIDAVIT STATE OF (FLORIDA) COUNTY OF (DADE) 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 The undersigned Affiant, ✓ a does hereby attest that ( roperty owner) The attached survey, performed by r6td , lQ Lj2ielt Mfg5 f- Ma/1 WC y, I n C �I d (Name of surveyor's company) For address: -I 1 G C -1 15b I rrace,00 1 a/Y) ► 6lore S Performed on Ja/alw6a (date of survey) is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits. FurthWUVau ht /icy knrq, Property Owner Signature Property Owner Print Name SWORN TO AND SUBSCRIBED before me this V� t" day of 1jino 019. Affiant is personally known to meproducedI l i . S� as identification. A �ppY P!Q/Fji \\\\\ ... O :9,� Revised on 5/22/2009/ Revised on 6/12/09 * ' • • C \ LOT 8, BLOCK 2 • ' "' ' "' F.F. ELEV. = 13.38' .... . . .... . ° °S Z (P.B. 39, PG. 41) • • • • • • • • • • • gz see•••°°•• PORTION OF THE 0.0 S.E. 1/4, N.E. 1/4, S.E. 1/4 OF SECTION 6-53-42 itlln {l}„ ern;{• 'r.., ii:ry:,{.v 63 z 165.00' (REC & M EAS) `.; `%;•:: `»:<><.._ 25.00' - 155.00'x. h j { t Y w 3'-2' C.B.S. WALL .S. WALL a. W 3 -6 Q.B.S. WALL 30.60, .00 9t ce).0 ca gii O, N cr Uj LLJ :r:>A,;LwLl W4.02 U/ O'er) �b 'YF i �%::; ".'..: . .Z �\ I�' li - . Z Qr• 1 N 20.00 V 26.25:. {s a, b m ADDITION O'!rY,a*:,\•:..).Y):wr<}:. � - � 'N ti �fo.�.:.,.:�.� � F.F. ELEV. — 13.56 " Ilk ':,�Y.',v{S • ,, n :';tax• 3 x ICI N ::: :'tti�:,,;;ti'{��Y'••'•`y..• "' �Y;rFa �:i°w:;-:;i•�.,ki''`}�.".'� o: r:;: {: i-;•:.; •::::r{/ r ask .;r : y.;.,f{G F'+ . • S ,: fit;3>:#:.'•; x ELEV 12 45' ��_'):;1}})A4•S4:titi:{:ySn!{:�:w':;:��si rr��rh::�y:�i: �:�i),iF"rt't;:iin:::! ;+f :r"".!:y/: n::,aii{<.\y{•:4:•i) t:;.i'.iii:•:�: �/.y -...: >.;:):::::3t 165.00' _.- REC & MEAS :;��,ir:'<':=:?'.•{:r?Sr:'r :'.yY'::'Z'.x - ','<:: :::3?'%fir,{.,�<'»:<� `r a. a 3'.t.f.'..4A.r N E 9TH AVENUE MIX � t�l:'i0�� L4�'£:� pit •:i� •;?:;' LOT 1 BLOCK 3 GOLDEN GATE PARK ADDITION (P.B. 6 PG 130) J a z H I U 0 z 0 N RECEi VEp W_ 0< 02 CO ' c ' On 7 } O s_ aw - ti�1� cu, iERM 3IT MIAMI SHORES VILLAGE T r , Y Z ka 0) O < (j APPROVED J r 00 W `t ZONING � Um J :TRUCTURAL 'IECTRICAL 'LUMBING `�Ak�CQL >LDG. DATE F dj,CT TO Co -,, � NI F1I ALL FEDERI• J,,TE AND COL;NiY-Ut L, , a -i ,C' 7 SITE L•OCAITION LAff4MLNLP )WHMOe71 "UINUM LIGHT POLE ;ELLSOUTH MAMLOLE IELsouTH TELEPHONE Box 3QMGNlURK ;ABLE Box :ATCH BASIN :ENTERUNE ,'BEAN OUT VALVE CHAIN LINK FENCE CONCRETE CONCRETE BLOCK STRUCTURE CONCRETE LIGHT POLE CONCRETE POWER POIE CONTROL VALVE DRAINAGE MANHOLE DRILL HOLE DUAL POLE SIGN ELECTRIC Box ELECTRIC METER ELECTRIC WARE OVERHEAD ELEVATION (EXISTING) ELEVATION (PROPOSED) FINISHED FLOOR FIRE HYDRANT FIRE MAIN VALVE TIM" PM " DDR MWAW YAIRM FORCE MAIN VALVE GARAGE GAS MANHOLE GAS METER GAS VALVE GUARD POST PON FENCE RON PIPE LIGHT POLE LIMITED ACCESS RIGHT OF WAY MAIN SEWER VALVE MAIL Box MANHOLE MEASURED MONUMENT NAIL NAIL AND OISC ON UNE PLAT BOOK POINT OF CURVATURE PERMANENT CONTROL POINT PAGE PROPERTY LINE PERMANENT REFERENCE MONUMENT RAIL ROAD GROSSING SIGN RECORDED INFORMATION RIGHT OF WAY SECTION SECTION CORNER SEWER MANHOLE SIGN SPRINKLER VALVE SWARE CUT AND NAIL STORM MANHOLE STREET LIGHT Box STREET SIGN TELEPHONE BOX TELEPHONE MANHOLE TRAFFIC SK NAL TRAFFIC SIGNAL Box VALVE WATER METER WATER VALVE Wood FENCE Wood LIGHT POLE WOOD POWER POLE ASPHALT BRICK CONCRETE TILE LOCATION MAP: NOT TO SCALE PORTION OF SECTION 6-53-42 LEGAL DESCRIPTION: The West 94.00 feet of the West 169.00 feet of the South 165.00 feet of the South 1 /2 fo the S.E. 1 L4 of the N.E. 1 /5 of the S.E. 1 /4 of Section 6, Township 53 South, Range 42 East, bode County, Florida; LESS AND EXCEPT the North Ten feet thereof. Presently in use as a portion of the Right—of—Woy for 91st Terrace. SURVEYOR'S NOTES: 1) The herein captioned Property was surveyed and described based on the shown Legal Description: Provided by Client. 2) This Certification is only for the lands as described. It is not a certification of Title, Zoning, Easements, or Freedom of Encumbrances. ABSTRACT NOT REVIEWED. 3) There may be additional Restrictions not shown on this survey that may be found in the Public Records of Miami —Dade County, Examination of ABSTRACT OF TITLE will have to be made to determine recorded instruments, if any affecting this property. 4) Accuracy. The expected use of the land, as classified in the Minimum Technical Standards (61G17-6FAC), is "High Risk Residential". The minimum relative distance accuracy for this type of boundary survey is 1 foot in 10,000 feet. The accuracy obtained by measurement and calculation of a closed geometric figure was found to exceed this requirement. 5) lines ofithe parcelrheorein gdescribed arecnot shown hereoboundary 6) Not valid without the signature and the original raised seal of a Florida Licensed Surveyor and Mapper. Additions or deletions to survey maps or reports by other than the signing party or parties is prohibited without written consent of the signing party or parties. 7) Contact the appropriate authority prior to any design work on the herein described parcel for Building and Zoning information. 8) Underground utilities are not depicted hereon, contact the appropriate authority prior to any design work or construction on the property herein described. Surveyor shall be notified as to any deviation from utilities shown hereon. 9) AREA OF PROPERTY: 14,570.00 Sq. Ft. or 0.334 Acres +/- 10) Ownership subject to OPINION OF TITLE. 11) Type of Survey. BOUNDARY SURVEY. 12) North arrow direction shown hereon is based on an assumed meridian: Along the East line of Lot 1, Block 3, of GOLDEN GATE PARK ADDITION as shown on Plat Book 6 Page 130. 13) Elevations are based on; National Geodetic Vertical Datum of 1929 14) Miami —Dade Bench Mark Used: L-12 Elev.: 7.04' 15) Bench Mark Location: 200' South and 20' East N.E. corner of Bridge N.E. 84th Street and N.E. 10th Avenue 16) Property Address: 17) Flood Zone: "X" 910 N.E. 91st Terrace Base Flood Elev.= N/A Miami Shores, FL FEMA Panel Number;120652-0093—J Date: July 17, 1995 18) This PLAN OF SURVEY, has been prepared for the exclusive use of the entities named hereon. The Certificate does not extended to any unnamed party. a. TOM & TRACY KNIGHT b. 19) Field Book: A-236, 16 & 17 W.O. No.:01-108-5401 Data Collector File: N/A SURVEYOR'S CERTIFICATE: I Hereby Certify to the best of my knowledge and belief that this drawing is a true and correct representation of the BOUNDARY SURVEY of the real property described hereon. I further certify that this survey was prepared in accordance with the applicable provisions of Chapter 61G17-6, Florida Administrative Code. FORD, ARMF?NTBROS & MANUCY, INC, LB 6557 Original Date Field: November 21, 1995 Revision Date: June 6. 2001 (Uppdate) Revision Date: December 23. 2002 (Update) Revision Date: ` BY4co l _ Radriguez, For i Fir Professional Surveyor an per, LS 5931